BMA facing backlash from members over handling of contract dispute

The British Medical Association is facing a major backlash from angry members and an exodus by medics disillusioned with its “appalling” handling of the bitter junior doctors’ dispute.

There has been a spate of resignations from the doctors’ union after it announced, then called off, a series of five-day all-out strikes in a failed attempt to stop the health secretary, Jeremy Hunt, imposing a controversial new contract on the 54,000 trainee medics in the NHS in England.

Members are accusing the BMA of being “spineless” and “incompetent” and of betraying junior doctors, and there are growing calls for the creation of a rival trade union to represent them. BMA leaders, one of whom admitted privately that it has ended up “in a big mess”, are worried that its handling of the year-long contract row has left it divided and weakened in defeat.

Junior doctors have inundated their Facebook discussion group with angry messages about the BMA and Dr Ellen McCourt, the chair of the union’s junior doctors committee (JDC). Some have posted screengrabs of cancelled direct debit forms, showing that they are rescinding their membership.

“I don’t want to just cancel my direct debit. I want to tell the BMA why I am withdrawing my subscription. I want to tell them how spineless they have been,” said junior doctor Mukhtar Ahmed.

He criticised the BMA for endorsing in May a revised contract that it had negotiated without seeking members’ views. The contract was later rejected by 58% to 42% in a referendum among junior doctors.

“I want them to know that these series of blunders have not only lost us this fight, but any future fight and the NHS as a whole. I believe in the power of the union but not this one,” Ahmed said.

The BMA is examining alternative forms of protest against the contract, which will start being imposed from next week. It is due to announce details this week, though the options under consideration are believed not to involve any form of industrial action, such as a work-to-rule or refusal to do overtime.

Many doctors are angry that they heard from the BBC rather than the BMA last Saturday night that the union had called off planned strikes. Junior doctor David Pye said: “I am done. I shall not be sending you any more money. I have put up with utter incompetence, fucking survey monkey polls to see what I think, leaks, power struggles and, for the third time, I find out our master plan via BBC news and not via my union. Goodbye.”

Increasing calls to set up an alternative organisation to represent trainee doctors intensified after the decision. “Time to form a new trade union – run by junior doctors and only for junior doctors. Getting recognised won’t be easy and it may take too long for this dispute but now the BMA has proven it is not fit for purpose, this is our only option for the future,” said medic Christopher Howarth.

McCourt and the JDC decided to abandon further industrial action in the campaign against Hunt after large numbers of junior doctors made clear that they had deep misgivings about taking part. BMA leaders feared that turnout might be as low as 20%, well down on the majority support during the eight previous days of industrial action between January and May.

A five-day strike due earlier this month was cancelled after the BMA admitted giving hospitals too little time to make arrangements to cope with the disruption. The first long stoppage was due to take place on 5, 6, 7, 10 and 11 October, despite warnings from senior doctors, medical bodies and the chief executive of NHS England, Simon Stevens, that patients would be at risk.

There is widespread anger among junior doctors at the cancellation, even though it appears that many of them were opposed to such a long stoppage. Many think the U-turn was merely the latest in a series of tactical blunders by the union in their unsuccessful battle to force Hunt to back down.

A sizeable minority of members of the BMA’s ruling council fear the union has done itself potentially irreparable harm and that the plan for five-day strikes has severely damaged public trust in doctors and left them looking uncaring and reckless. Some believe that Dr Mark Porter, the union’s leader, allowed its JDC too much freedom under McCourt and her predecessor, Johann Malawana, to decide its own tactics.

In a post on the Facebook site in response to the torrent of online anger, McCourt insisted the junior doctors’ campaign would go on. Defending the cancellation, she said: “We had a choice that included continuing the current planned industrial action, changing the planned IA or suspending the action. The JDC, having weighed up the new information, debated the options and voted to suspend the IA and pursue other means of resisting the contract. This does not mean the fight against imposition and this contract is over.”

BMA facing backlash from members over handling of contract dispute

The junior doctors’ dispute is about the future of the NHS | Letters

Deborah Orr asks for a clear message from the junior doctors (Junior doctors, what exactly is it you are striking for?, 3 September). I am not a junior doctor but perhaps I can help. The NHS can barely staff a five-day routine service (emergency care is already 24/7). So stretching the same staff over seven days will make the service unsafe and a junior doctor’s job intolerably stressful. A seven-day NHS cannot be delivered on a five-day budget. The NHS is under direct attack by the most pernicious health secretary in a generation and the junior doctors’ contract is part of this attack. The junior doctors have the courage to call it how it is and are attacked by columnists who claim to care about social justice. Aneurin Bevan said: “The NHS will survive as long as there are folk who are willing to fight for it.”
Dr Jon Dickson
Sheffield

• Deborah Orr states that “more senior medical professionals” – presumably consultants – “would like to be generously compensated if they started being asked to turn out for weekend shifts themselves”. How many times do we need to explain to journalists that all doctors, including consultants, already work at weekends? There are fewer of them than during the week, because there are no routine outpatient clinics or operating lists, but they all take their turn on the rota to cover emergency work and deal with inpatients. The idea that hospitals are somehow devoid of senior doctors at the weekend is a myth, as is Jeremy Hunt’s assertion that simply increasing the numbers of junior doctors at the weekend will allow him to introduce the “seven-day NHS” – whatever that means.
Dr Bob Bury
Leeds

• Studies in Oxford, Manchester and York have shown that there is no “weekend effect”. The number of patients dying on Sundays is the same as any other day, possibly slightly fewer. The electoral slogan was devised by political spin-doctors to divert attention from the underlying problems of the health service. Why then are politicians and exorbitantly overpaid administrators attempting to arrange the working practices of junior doctors? Doctors are already working weekends. Let them arrange their weekend rotas within the constraints of an overstretched NHS, and end this controversy. Jeremy Hunt`s arrogant stance following the cabinet reshuffle – rumours of my demise have been much exaggerated – is an unacceptable slur on all those working at the bedside. Time for a change.
Emeritus professor Sidney Lowry
Bangor, Co Down

• Like many medics, I have been saddened by the trend throughout the present century for the NHS and local authorities to contract out an increasing part of their treatment and care services to the private sector, given the risk that private sector providers will care more about their profits than their patients. For the BMA to have reneged on the terms to settle the junior doctors’ dispute which they accepted earlier this year, and to threaten strike action on the scale now announced, suggests that the medical profession too cares more about the profits its members make from the NHS than about their patients. I am about to resign as a BMA member.
Professor Ian Leck
Woodstock, Oxfordshire

• The outcome of this dispute will affect more than the junior doctors: the future of the NHS is at stake. On 9 May, before the health select committee, Jeeremy Hunt advocated “moving forwards … towards the kind of budgetary arrangements you would find in … Kaiser Permanente’’. Kaiser Permanente is the largest private health maintenance organisation in the US, and one of the subjects of Michael Moore’s film Sicko about the dire state of healthcare in the US. Hunt and the government aim to run the NHS into the ground so it can be taken over by this private company and its ilk.
Professor Fay Dowker
London

• What your headline (NHS ‘needs EU employees to avoid collapse’, 25 August) fails to acknowledge is that the government doesn’t mind if the NHS collapses. In fact, it has been the neoliberal plan for several decades. The NHS has been brought to the point of collapse by deliberate underfunding (not “overspending”), a hospital and bed closure plan (we now have less than one third the beds per head of population than Germany), shortsighted manpower planning and cynical scare stories about safety.

This is all presided over by the NHS chief executive Simon Stevens, former vice-president of the US private healthcare company UnitedHealth, and a secretary of state, Jeremy Hunt, who was co-author of a book calling for the end of the NHS (another co-author was Greg Clark, secretary of state for business, energy and industrial strategy). Meanwhile their friends like Richard Branson are circling like vultures.

The result will be no recognisable NHS in a few years time (Oliver Letwin gave it five years) – not by accident but by design.
Dr Paul Hobday
Leader, National Health Action party

• We’re disturbed by David Babbs’s article (Politicians have failed the NHS. We need people power to save it, 26 August). The 38 Degrees report on NHS “sustainability and transformation plans” to which he refers doesn’t point to what’s behind NHS England’s carrot-and-stick strategy.

By offering additional funding for NHS commissioners who satisfactorily reduce their deficits and by threatening punitive “special measures” for those who don’t, the STPs will serve private sector interests. NHS cuts to reduce deficits will mean the NHS, and the public, having to seek more services from the private sector. More public money will benefit private companies whose services cost far more than a publicly funded, publicly run NHS. Less accessible services and longer waiting times will push the public to pay for private health insurance.

Babbs omits to mention US influence in NHS restructuring, which Jeremy Hunt has acknowledged. Major US consultancies and healthcare corporations like McKinsey and UnitedHealth are heavily involved. But he confirms that 38 Degrees commissioned Incisive Health, lobbyists for Virgin Healthcare and the privatisers’ NHS Partners Network, to produce its crowdfunded report. It’s not surprising it glosses over what the STPs prefigure – the replacement of an NHS once recognised as world leading in cost-effective public healthcare by a privatised system whose providers’ financial interests will have undue sway. As members of 38 Degrees, we think it’s vital that it isn’t seen as an NHS privatisers’ tool.
Barbara Beese, Julia Campbell, Verite Reily Collins, John Furse, Jim Grealy, Merril Hammer, Karl Hevera, Ian Irvine, Tina Mackenzie, Craig Nicol, John Ralph, Linda Robinson, Teresa Schaefer, Heinz Schumi, Margaret Spector, Alexandra Veres, Martin Woodford
38 Degrees Chelsea and Fulham Group

• Sustainability and transformation plans are being drawn up in conditions of secrecy imposed by NHS England – as its North Midlands director of commissioning operations, Wendy Saviour, told a recent meeting of Shropshire clinical commissioning group: “STPs are not meant to be published at all. They should not go to board meetings. Some of them contain very radical things… These are highly political and highly contentious. Once they’re washed off and the national messages are gathered together, they will be published.”

We think this is an appalling abuse of our democratic rights and call for protests at local authorities’ health and wellbeing board meetings, clinical commissioning group meetings and at NHS England offices. Health and wellbeing boards are notionally responsible for seeing that STP governance and decision-making processes “maintain democratic legitimacy”. Councillors need to explain how this is possible given there is no statutory basis, and how they can square their duty to represent and fully inform us, whilst colluding in NHS England’s imposition of secrecy and dubious legality.

STPs are highly political and highly contentious because they involve huge cuts and NHS privatisation by a process of parcelling up the NHS into a new form of public/private partnership called accountable care organisations – think PFI, but for services as well as buildings. The unacceptable outcome will be an NHS that offers reduced services, ends national terms and conditions for staff and is modelled on private American health insurance schemes.
Jenny Shepherd Chair, Calderdale and Kirklees 999 Call for the NHS
Steven Carne 999 Call for the NHS
Madeleine Dickens Sussex Defend the NHS
Dr Alex Scott-Samuel
Jackie Grunsell GP
Ted Schrecker Durham University
Colin Hutchinson FRCOphth
Deborah Harrington National Health Action party campaign team
Christine Hyde North Kirklees Support the NHS
Jackie Brook and Chrissie Parker Friends of Huddersfield Royal Infirmary
Ian Wonnacott Psychotherapist
Rosemary Hedges Secretary, Calderdale 38 Degrees NHS Campaign
Coral Jones GP
Andrea English Advanced nurse practitioner
Dr Mike Galvin
Mel Walker Children’s learning disability nurse
Victoria Kennedy Huddersfield KONP
Sandra Shearn Calderdale 38 Degrees NHS Campaign
Dave Ash National Health Action party executive
Paul Cooney Huddersfield KONP
Carol Ackroyd Secretary, Hackney KONP
Jean Hardiman Smith Defend Our NHS Cheshire
Julie Ingram Barnsley Save Our NHS
Stephanie Clarke Calderdale 38 Degrees NHS Campaign
Jody Clark Fighting 4 Grantham Hospital
Stephen Maclean Chair, Sussex Partnership Unison branch

• Join the debate – email guardian.letters@theguardian.com

The junior doctors’ dispute is about the future of the NHS | Letters

The Observer view on the BMA and the junior doctors’ dispute | Observer editorial

“Safe”; “fair”; “a really good package of things for equalities”. This was how Ellen McCourt, the new chair of the British Medical Association’s junior doctor committee, described the renegotiated contract the BMA agreed with the Department for Health earlier this year. Yet just weeks later, the BMA has announced an unprecedented level of strike action over that same contract: four five-day strikes, including the removal of emergency care. How have we got here?

After more than three years of contract negotiations, it’s easy to lose sight of why the junior doctor contract was being renegotiated in the first place. All sides agreed the old contract – which resulted in unpredictable pay packets, and equal rewards for doctors working very different levels of unsocial hours – was unfit for purpose.

Despite protracted negotiations neither side has been able to reach agreement. Before the summer, the BMA and the government finally agreed a new compromise contract after eight days of intensive Acas negotiations. Yet despite the BMA endorsement, junior doctors rejected this contract by 58% to 42% in a vote.

This left the BMA in somewhat of a quandary. But having recommended the contract to its members as fair and safe, it is impossible to make sense of its decision to aggressively escalate strike action in the wake of the vote.

For medical professionals, the decision whether to strike must be one of the utmost gravity. Every day of strikes means thousands of operations cancelled, causing huge patient suffering. Withdrawing emergency care at short notice for sustained five-day periods creates serious risks to patient safety.

In the past, the BMA has justified strike action by arguing that the government’s proposals – even after significant modifications made in February – represented an even bigger risk to patient safety, although it failed to set out a convincing public explanation of why and how that was the case. But to escalate strikes on the basis of a contract the BMA itself has declared safe seems bizarre at best. At worst, it leaves the BMA vulnerable to the charge these strikes are politically motivated.

As this paper has argued, the government has been far from blameless in this dispute. Jeremy Hunt originally approached the negotiations in an unnecessarily combative style. His decision to rhetorically link contractual reform to an unfunded Conservative manifesto commitment for seven-day NHS services was a mistake, and had an incendiary effect. But the government has shifted its approach in recent months, making significant concessions.

Yet as the government’s approach has become more conciliatory, the BMA has upped the ante. The public has the right to expect industrial action should be deployed as an absolute last resort given doctors’ ethical responsibilities. But the Health Services Journal has published leaks of private messages between the BMA’s junior doctor committee that suggest that – far from being deployed as a last resort – strikes were seen as a tool to prolong the dispute, causing maximum difficulty for the government. One committee member said weekend pay was “the only real red line” for doctors, directly contradicting the BMA’s public stance that this was a dispute about patient safety.

It remains unclear what this strike is actually about. In the media, the BMA and many grassroots doctors continue to argue it is about the government putting patient safety in danger by pledging to deliver seven-day services across the NHS without increasing the number of staff. But the contract itself neither requires doctors to work more weekends, nor reduces staffing during Monday to Friday. It emerged yesterday that in May the Department for Health was willing to issue a statement to junior doctors that made clear seven-day services would be limited to emergency care, with extra staff deployed. The BMA at first signed off this statement as part of the Acas process, then insisted the department refrained from releasing it as they regarded it as irrelevant to the contract.

This clarification could potentially have won more junior doctors round to voting for the compromise contract. Why did the BMA not want this statement publicised, and why are its leaders continuing to argue this contractual dispute is about the government’s commitment to seven-day services? In the absence of a good explanation, it is hard to avoid concluding this dispute has morphed from an industrial one about contractual reform into a political attack on the government, with insufficient regard for the cost in patient suffering.

There is also evidence the BMA might be out of step with its members. Just 32% of the 7,000 doctors that took part in a leaked BMA survey back in May said they supported time-limited strike action, and 36% unlimited action. Despite its serious escalation, the BMA has not balloted its members on strike action since last November.

Of course junior doctors work long hours in difficult conditions. Many have legitimate grievances, including serious concerns about the current NHS funding crisis. But these grievances are not contractual. Using escalated strike action on the basis of a contractual dispute to air these grievances may be tempting, but it is ultimately counterproductive.

This paper is a staunch defender of the critical right to take industrial action. But with that right comes responsibilities. The BMA’s leadership, looking increasingly driven by political rather than industrial concerns, has failed in those responsibilities: to its members, to the NHS, and ultimately, to the public.

The Observer view on the BMA and the junior doctors’ dispute | Observer editorial

Junior doctors consider further strikes in contract dispute

Junior doctors are considering further strikes in September after rejecting the health secretary Jeremy Hunt’s proposed new contract.

Ellen McCourt, who chairs the British Medical Association’s (BMA) junior doctors committee, said that by standing together they could demand the government takes them seriously.

Strikes took place between January and April after junior doctors failed to come to an agreement with the government. In July the government announced it would impose a contract after junior doctors and medical students voted to reject a deal brokered with the BMA.

In a letter to members released on Thursday night, McCourt said the government had remained “persistently silent” on the issues she said had led to the rejection of the contract.

— #hellomynameisEllen (@McCourtEllen) August 11, 2016

The road ahead will not be easy,by standing together we speak with one voice,our unity remains our strength @TheBMA pic.twitter.com/DAuXhf5fjS

She said: “In light of this, the JDC executive has voted to reject the proposed new contract in full and to call for formal renegotiations on all of your concerns.

“In response to the government’s silence, JDC exec has today made a formal request for a special meeting of BMA council to authorise a rolling programme of escalated industrial action beginning in early September.”

She said the BMA could not stand idly by as the date for imposition drew nearer, and argued that forcing a contract on doctors that they did not have confidence in would be bad for patients.

Daniel Mortimer, the chief executive of NHS Employers, said: “Industrial action achieves little or nothing but places pressure on already stretched teams and services and causes worry, distress and disruption for patients, carers and their families.

“Over the last two months we have been talking with the junior doctors committee and have, along with the Department of Health and others, responded positively to their concerns regarding the guardian role and whistleblowing.”

He said employers were serious about “positive engagement” with the BMA.

Junior doctors consider further strikes in contract dispute